This study aimed to compare the effect of preventing radiographic progression (in its three components) of tocilizumab (TCZ) monotherapy with those of TCZ combined with methotrexate (TCZ+MTX). Also, to evaluate possible effect modifiers. Randomized trials comparing TCZ‐monotherapy with TCZ+MTX combination therapy regarding radiographic progression were analyzed on individual patient (n=820) data levels for early and established RA patients using mixed‐effects models.
Overall, TCZ+MTX was more effective in preventing radiographic progression regarding total SvdH scores compared to TCZ‐monotherapy. However, in early RA patients with more joint damage, or a lower DAS28 at baseline, this advantage disappeared. In established RA, the advantage of TCZ+MTX over TCZ in preventing radiographic progression disappeared with a longer disease duration at baseline. Results for erosion scores as outcomes were in line but were less clear for JSN.
In conclusion, combination therapy with TCZ+MTX is more effective in preventing radiographic progression compared to TCZ‐monotherapy. However, the effectiveness of TCZ‐monotherapy may approximate the effectiveness of TCZ+MTX in early RA patients with more joint damage and a lower DAS28 at baseline and established RA patients with longer disease duration.
Ref: https://onlinelibrary.wiley.com/doi/10.1002/acr.24524
